Provider Demographics
NPI:1720026289
Name:HAGER, TERRI (MSW, LISW)
Entity Type:Individual
Prefix:
First Name:TERRI
Middle Name:
Last Name:HAGER
Suffix:
Gender:F
Credentials:MSW, LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 N KENILWORTH AVE APT 5H
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60301-1224
Mailing Address - Country:US
Mailing Address - Phone:708-613-5211
Mailing Address - Fax:
Practice Address - Street 1:151 N KENILWORTH AVE APT 5H
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60301-1224
Practice Address - Country:US
Practice Address - Phone:708-613-5211
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-04
Last Update Date:2022-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0158201041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCQ31849Medicare UPIN